Development Assistance for Health: 4 Key Developments to Watch for in 2019

2018 has been a year of many firsts that could help to mobilize global health financing and improve collaboration among global health actors.  Among these firsts, the Global Financing Facility’s (GFF) first replenishment, China’s establishment of its new aid agency, and a global action plan uniting the leading health multilateral agencies together for accelerating progress towards the Sustainable Development Goals (SDGs) stand out. 2019 is also shaping up to be a crucial year for global health development assistance.

Here are the top things I’ll be watching in the coming year:

  1. Replenishment Mania

GFF kicked off the health replenishment cycle in Norway last month with somewhat disappointing results: donors agreed to provide $1 billion to the GFF, achieving half of its target of $2 billion. More pledges may roll in after the fact, but it could be complicated to do so amidst the health-related multilateral replenishment mania coming in the new year.

France will host The Global Fund’s sixth replenishment in October where the organization will raise funds for 2020-2022. In advance of the Global Fund replenishment, India will host a preparatory meeting in February.

The World Bank’s International Development Agency (IDA) launched its IDA19 replenishment last month in Zambia where participants “agreed to retain the special themes of IDA18, while underscoring the importance of adapting and leveraging the opportunities opened by disruptive technologies and building on the momentum created by the Human Capital project, stressing the cross-cutting aspect of these issues.” There will be three replenishment meetings in 2019 (April, June, and October) before the pledging session in December 2019.

Gavi’s third replenishment will take place in 2020 for its 2021-2025 funding cycle. Details are scant at the time of writing, but it will be interesting to see how its approach shapes up following the experiences of GFF, Global Fund, and IDA.

The Center for Global Development (CGD) found that over the last three replenishment cycles, major multilateral funds (e.g. IDA and African Development Fund) have seen decreasing contributions from donor countries whereas thematic funds (e.g. Gavi and the Global Fund) have seen increasing donor contributions. Let’s see if this trend continues next year.

  1. All Eyes On Asia

Asian donors have increasingly captured the attention of the global health and development community.

Japan has historically prioritized global health in its diplomatic engagements and its 2016 G7 presidency was no exception. Japan included global health, and universal health coverage in particular, as one of its top priorities. In June 2019, Japan for the first time will host a G20 summit—the 2019 G20 Osaka Summit. The main themes are currently under preparation, but Japan’s track record at these political forums shows strong support for elevating the role of global health. The G20 health ministers’ meeting will be held in October in Japan.

The Eminent Persons Group proposed several recommendations to the G20 in its October 2018 report on ways to reform the global financial system, including development finance.  The report makes three key points and focuses particularly on how the multilateral institutions need to have a systems approach to development finance. Many will be watching to see if these recommendations are adopted by the G20 under Japan’s leadership next year.

China’s new aid agency, announced in March 2018, has been of keen interest to all China watchers. Details on the China International Development Cooperation Agency (CIDCA) are still sparse. For example, the CIDCA website launched several months following its establishment but it leaves much to the imagination. However, an interesting development happened last month: CIDCA published a new management document that “calls for the CIDCA and other government agencies involved in overseas investment to fully evaluate the project with which they are involved,” and opened the document for public comment until mid-December. Despite China’s decades long global health engagement, this is the first time China has called for evaluation or risk assessment of its global projects. This call is likely in response to accusations of “debt-trap diplomacy”, a term critics use to describe China’s predatory lending practices to low- and middle-income countries, but it is still a step in the right direction. The final version of CIDCA’s management guidelines, in addition to more detail about what the agency has planned for the future, will hopefully be available in 2019.

  1. The Global Action Plan: Phase 2

The Global Action Plan for Health and Well-being for All was signed by 11 health-focused multilateral agencies at the World Health Summit in October 2018. This historic move seeks to unite the work of these organizations “to enhance collective action and accelerate progress towards the Sustainable Development Goals.” The initial commitment documents signed at the October meeting map out the preliminary vision for this joint effort and intends to affect their collective organization, investment, programming, and measurement.

11 signatory organizations of The Global Action Plan for Health and Well-being at the World Health Summit in October 2018

Highlighted in the plan was strengthening the provision of global public goods (GPG) for health, a topic of great interest to the Center for Policy Impact in Global Health. We recently argued that it will be critical to come to a consensus definition of GPGs for health.  We also published a set of recommendations for how key multilaterals could intensify their cooperation around three key opportunities.

The final Global Action Plan is expected to be delivered at the 2019 UN General Assembly. Until then, organizations will map out their roles and functions and come up with ways to better coordinate their work to accelerate achievement of the health-related SDGs.

  1. Shifts in Global Health Leadership

The Organization for Economic Cooperation and Development (OECD) Development Assistance Committee (DAC) elected a new chairwoman, Susanna Moorehead from the United Kingdom, in December 2018. Moorehead joins amidst ongoing reforms begun by her predecessor and major shifts in the aid landscape. OECD’s recent report, Global Outlook on Financing for Sustainable Development 2019, shows that not only have donor countries not followed through on their 2015 pledge to increase development assistance, but also there was a 12% decrease in external finance to low- and middle-income countries from 2013-2016. The report makes further calls to enhance domestic financing for development and overhaul the development finance system. This comes just before the DAC released a statement stating that members could not reach a consensus for how to report aid spending via private sector instruments.

DAC’s two largest funders for health—the United States (US) and the UK—are going through significant changes at home. Under the Trump administration’s leadership, the US Agency for International Development (USAID) Administrator Mark Green has steered the organization towards a reframing of aid through the Journey to Self-Reliance. Although it is still unclear if and how the self-reliance indicators will be used to influence its funding allocations, 2019 is certainly sure to reveal more about this major organizational shift.

The Trump administration has positioned the US as an alternative to China in terms of development finance (e.g. Vice President Pence’s remarks at the November APEC summit), and Administrator Green recently echoed similar sentiments to others in the administration, referring to China’s “authoritarian approach” to development. Although the Obama administration wasn’t always friendly towards China’s global development rise, Green’s frank depiction of US-China development competition is somewhat new.  Scott Morris at CGD highlights that although US-China development competition presents many risks, there is one silver lining: this competition was a likely impetus for the establishment of the new US International Development Finance Corporation.

As we close out 2018, the second largest government funder for global health, the UK, is still uncertain about its Brexit plan. Brexit will affect not only UK citizens, but also recipients of UK aid, and aid collaborators (see here and here). The extent of Brexit’s impact on all relevant stakeholders is currently unknown. Will the UK retain its leadership in aid and aid for health as it exits from the European Union? It’s too early to say but we will be watching.

2019 is sure to bring some unexpected surprises in the field of global health aid landscape. So keep monitoring our blog, follow us on Twitter @dukecpigh, and stay up to speed on our latest research by signing up for our mailing list.


Kaci Kennedy McDade  ( @Kennedy_Kaci) is a Policy Associate at the Center for Policy Impact in Global Health, Duke Global Health Institute.